Business Analyst

ALEKHYA GUMMADI

E-mail:

*********@*****.***

; Phone: 916-***-****

Senior Business System Analyst

Summary:

* ***** ** ********** ** Senior Business System Analyst with strong Analytical and strong problem solving skills, uphold excellent interpersonal communication while working on long, complex and tedious assignments.

Effectively delivered multifaceted projects using methodologies of SDLC like Agile, Waterfall, and RUP.

Expertise in generating and evaluating Business Requirements Documents (BRD), Functional Requirement Documents (FRD), System Requirement Specification (SRS) and Work Breakdown Structure (WBS) and recommend changes as per the applicable internal and external requirements gathered for process improvement.

During process development, documented and verified with the help of Requirements Traceability Matrix (RTM).

Experienced in employing Revenue Cycle Management (RCM) to enrich healthcare delivery.

Skillful in directing Joint Application Development (JAD), meetings, project meetings, reviews, walk-ins, and customer interviews.

Had good experience in creating Use Case Scenarios, process modeling using Use Case Diagrams, Data Flow Diagrams, Activity diagrams and Sequence Diagrams using MS Visio and Rational Rose.

Extensive knowledge of Medicaid, Medicare, Procedural and Diagnostic codes and Claims Process.

Strong knowledge of Health Insurance Portability & Accountability Act (HIPAA) standards, Electronic Data Interchange (EDI), transaction syntax like ANSI X12, Implementation and knowledge of HIPAA code sets, ICD-9, ICD-10 coding, HL7, HMO, PPO.

Excellent knowledge of FACETS.

Presented several documents and Use Cases for multiple transactions and worked with ANSI X12 5010 including the standards for medical transactions like 837I, 837P, 835, 276, 277, 270, 271(both inbound and outbound) transactions for ongoing industry projects.

Efficient and proven track record with handling Change Requests by the Clients.

Proficient in working with project management tools like MS Project for status reporting and planning.

Well versed with Medicaid Management Information Systems (MMIS), National Provider Identification (NPI) and familiar with Patient Protection and Affordable Care Act (PPACA), Health benefit Exchange.

Good knowledge of Health Insurance Plans (Medicare Part A, B, C and D), managed care concepts (Medicaid and Medicare) and experienced in determining the membership eligibility, billing experience within life and disability in health plans.

Testing: Regression, System, UAT, Integration and Load testing

Experience with Business Process Management.

A motivated, committed, quick learning, detail-oriented team player with good communication, analytical, leadership, interpersonal and problem solving skills.

Technical Skills:

OPERATING SYSTEM

Windows Server, Windows, UNIX

TESTING TOOLS

HPQC, Load Runner, Quick Test pro

FRONT – END TOOLS

Adobe Photoshop, MS Excel, MS Office, MS Project

LANGUAGES

C, C+ +, HTML, XML, UML,

REQUIREMENT MANAGEMENT

Rational Requisite Pro, Caliber RM

MODELING TOOLS

MS Visio, Rational Rose, Caliber RDM

PROJECTMANAGEMENT TOOLS

MS Project, Share Point 2010, JIRA, Primavera

BUG TRACKING TOOLS

Rational Clear Quest, Rational Clear Case

METHODOLOGIES (SDLC)

Scrum, Agile, Rational Unified Process (RUP), Waterfall Model

DATABASE

Oracle, MS SQL Server, MS Access

PROFESSIONAL EXPERIENCE:

New York Medicaid State Project, New York, NY Jan 2015 – Present

Sr. Business Analyst

The project was to enhance existing claims submission, Eligibility, claim processing module of MMIS.

I also worked on Writing Integrated Eligibility requirement for NY state future vendor so IE can be implemented easily with right NY configuration.

Responsibilities:

Proposed strategies to implement system-wide changes in the new MMIS system.

Documented business requirements, and communicated these requirements with the development team for design and implementation of business solutions.

Modified existing policies with NY Medicaid to improve the process.

Worked on creating process and policies to handle Medicaid Child support claims.

Worked with Business Analysis team to prepare a detailed Business Requirement Document.

Analyzed Business Requirements to develop Functional and detail Design Specifications of the application.

Involved in writing Eligibility rules for Medicaid and SNAP and also Worked on process flow of the eligibility system.

Validated state existing eligibility rules with federal rules to avoid penalty.

Reviewed all the policies with NY State as well to make sure they are aligning with state rules.

Conducted Requirement Gathering Sessions with the stakeholders.

Conducted the JAD sessions, daily meetings, brainstorming sessions to solve the problems and enhance the workflow.

Interacted with the project team to help define the Business and System Objectives, confirmation of scope, identify constraints and the measures of success for the system to be developed.

Developed the project using Agile Methodology, i.e. Scrum which is the framework. Acted as Scrum Master facilitating Daily scrum meetings about the Status, Planning and issue updates.

Hands-on- Experience on JIRA, An Agile project management tool.

Worked on processing Medicaid claims and validated eligibility for enrollment.

Worked on MMIS on up gradation of different modules.

Perform requirement analysis and validated requirement.

Created documents like BRD/FRD/Data mapping specification, User Interface specification etc.

Handled and reassign the requirement tasks between team members to increase the performance.

Assisted in building a Business analysis process model using Rational Rose and Visio.

Gathered Functional Requirements from users and the management. Coordinated all the requirements in team based environment.

Went through all the mutual policies and documents with other Business Analysts from NY Medicaid to modify the rules on payment rules, payment process and customer satisfaction.

Acted as liaison between the senior management and different teams with effective presentations.

Experience in Rational Rose & HP Quality Centre.

Applied Revenue Cycle Management (RCM) to imply efficient healthcare delivery.

Monitored change requests and documented requirements, integrating them with Use Cases.

Incorporated stakeholder feedback throughout project lifecycle to ensure project quality and customer satisfaction.

Did Technical documentation for the project using tools like Visio, Word, etc.

Wrote Test Script on EDI 835 X12 segments in Excel sheet in UAT testing.

Exported all the test script in HP Quality Center by Mapping in UAT.

Executed test cases on Medicaid provider data and claim (EDI 837) in QC and logged defect in defect tab in QC.

Performed analysis on defects and closed them once problem resolved.

Used MS Project for managing schedules, resources and collaboration.

Environment: MS Office, SQL, MS Project, MS Visio, Unix, XML, Windows, HP Load runner, HP Quality Center.

SCAN Health Plan, Long Beach, CA July 2013 – Dec 2014

Business Analyst

Scan Health Plan is a not-for-profit Senior Care Action Network. Scan is committed to helping bridge the gaps between what’s needed and what’s available to help seniors stay Healthy and Independent.

The project was about implementing a federal mandate to replace the ICD-9 Diagnosis codes with the ICD-10 Diagnosis code set, and also assisted with Automated Claim processing system.

Responsibilities:

Involved in requirements gathering sessions with SME’s (Subject Matter Experts), Business Analysts and Architects to understand requirements in terms of business.

Played a major role in collecting, documenting, blueprinting and managing business requirements.

Actively worked on Business requirement analysis and Data analysis pertaining to various areas of Facets.

Worked at different stages of Software Development Life Cycle (SDLC) with business users, developers, and stakeholders.

Worked on business process from taking a requirement from a system record to a centralized database.

Gathered requirements and developed crosswalks for 270/271, 834, 837 P/I claim.

Employed Revenue Cycle Management (RCM) to imply in healthcare delivery.

Developed test cases based on the crosswalks and compliance guidelines for 834, 837 Professional, Institutional and Dental claims and for 270/271 eligibility benefit inquiry and response

Involved in various aspects of QNXT lifecycle.

Constantly in touch with business to work on policies in place to modify them on timely basis.

Generated test data using X12 generator for transactions 277/288, 834, 835, 837P/I/D.

Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams using MS Visio.

Participated in Forward and Backward Mapping analysis of ICD 9 – ICD 10 using GEM provided by CMS.

Designed and analysis of HIPAA 5010 related to 837,835, 834 transactions and formulated General Equivalence Mapping (GEM) documentation between ICD-9 and ICD-10, and vice-versa for the modules in production, conducted feasibility study and performed impact analysis for proposed enhancements

Actively worked with quality control teams to develop test plans and test cases.

Developed tables, Views, Stored Procedures and Triggers using SQL Scripting.

Established Inner Join, Outer Join and created Indexes whenever necessary.

Writing Standard SQL queries and optimizing SQL Queries

Responsible to meet the information demands of our business users by delivering timely, accurate, meaningful and standardized data and reporting.

Developed test scenarios and implemented test plans for system test and user acceptance test (UAT).

Environment: SQL, UML, MS Project, SQL Server, MS Vision

The Cleveland Clinic Foundation, Cleveland, Ohio May 2012 – July 2013

Business System Analyst

Using the internet as a tool, e-Cleveland Clinic provides online billing system including modules like Patient Data capture, Charge capture and Checkout, Medicare and Medicaid Claims, Reports and Management, patients online second opinions, health news and complete health charts regardless of their location, eliminating the time and expense of travel. Medtronic products were used by physicians such as diagnostic equipment. It combines the patient data module, doctor-patient live chat system, patient surveys, web appointments and health insurance validation modules.

Responsibilities:

Created complete test cases of varying complexity, executing tests, measuring expected and actual results, and reported status ensuring accurate coverage of requirements

Set up test requirements, developed test plans, and documented manual test cases using Quality Center requirements module.

Managed all types of functional change requests in the ‘patient’ module of the application, including defects, enhancements, issues and documentation changes with a flexible workflow process using Quality Center

Verified the software and applications according to the requirement specifications (SRS) and generated detailed test coverage reports and graphs twice a week

Worked closely on documentation in regards to GMP and traced it through various procedures to ensure quality and avoid contamination.

Involved in validation of HIPAA 834, 270/271 EDI transaction codes.

Developed the Project using the Waterfall Model. The Project was streamlined through all phases of the Waterfall Model starting from Planning through Implementation.

Designed message formats, queues, legacy systems interfaces, and worked with the business users through interviews and Joint Application Development (JAD) sessions. Created front-end prototypes as deliverables and projected the end-delivery modules.

Conducted data Driven tests in Win Runner by parameterization, worked with the data table, modified the script for data-driving, and wrote SQL statement in Script to retrieve data from database.

Prepared requirement specification, functionality trace matrix, quality assurance plan and designed test cases. Communicated with business, technology leadership for overall project/program office milestones.

Evaluated application testing results and recorded the discrepancies using Quality Center to track, analyze and report on them.

Used Quality Center as a repository for Test Cases and Test Scripts. Responsible for monitoring the defect tracking process and generating customized reports using Quality Center. Interfaced with developers to resolve the bugs following the bug life cycle policy.

Environment: Quality Center, Rational RUP, UML, Quick Test Pro, SQL Server, MS-Project, MS Visio, HIPAA compliances

Valence Health, Seattle, WA Jun 2011 – May 2012

Business Analyst/Data Analyst

This project involved the development of a user-friendly, inter-operable web application that provides online account services like bill paying, bill history, and eligibility verification. To providers of Valence health, exchange of health information is also enabled for easy immediate access to patient’s health record securely over the web. This web application can thus track medical history and medical plans of the patient using the available electronic health records.

Involved in Data Analysis team, and documented them and converted to business requirements, also Designed Data Flow Charts.

Responsibilities:

Facilitated conduction of stakeholder interviews for identifying requirements followed by analysis of requirements

Supported in collecting HIPAA related EDI transactional data from data warehouse

Worked on changes of implementation, expected of HIPAA transactions EDI 837,835, 270/271,278,834 in future upgraded system.

Conducted analysis on existing system and gathered user needs, programming needs for development of new product, For Coming up HIPPA changes.

Conducted status report meetings with developer’s team and business team on weekly basis

Designed process flows for the enhanced system as well as the existing system

Created Use cases, Test cases, Process flows, Test plans for QA team and noted user observation during testing product before release

Worked on basic SQL queries for testing and data validation

Analyzed and documented the scope of the project and kept track of changes throughout the life cycle of the product

Assisted in logical and physical design sessions and also in documenting developed designs

Involved in Working on the development of GUI designs for the product

Worked on health records providing system as a part of Customer Relation Management

Assisted business users by providing support about the application and database after project went live

Environment: MS Visio, MS Office, Rational Suite (Requisite Pro, Clear Quest, Clear case), Load Runner, SQL, Java, Windows XP

Apollo Hospitals, Delhi, India Feb 2009 – Dec 2010

Business Analyst

The main purpose of this project was to develop Patient Management System which can handle history of patient related to their Health, Diagnosis, Procedures, Deposits, Visits Etc.,

Responsibilities:

Liaison between the Business needs (business users and sponsor) and the Technical solutions (development and testing staff), ensuring technical solutions satisfied business requirements.

Web Page Mock-Ups using MS Visio and thus defining the Business Process Model and Data Process Model.

Experienced in RUP software development cycle methodology with four consecutive phases - Inception, Elaboration, Construction and Transition.

Authored Business and Functional requirements with supporting diagram, use cases, traceability matrices, and training manuals for Provider Portal web-based application.

Developed training material and trained the users on newly developed application.

Analyzed and wrote technical documentation for risk analysis on customer support issues.

Part of the team assisting in documentation involved in this project such as RFP, proposal, evaluation criteria, proposal approval, design document, project plan, project scheduling, project report, release document.

Prepared and presented monthly collection reports.

Involved in training and quality of the overall workflow process.

Documenting workflow and results of analysis for the aging accounts.

Environment: RUP, Rational Requisite Pro, UML Use Cases, VB.NET, SQL Server, Rational Rose, XML, Use Case Documentation.

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